GPhC Medicines Optimisation 2 — Questions and Answers
Question 1: Which of the following best describes medication adherence?
- The extent to which a patient follows their prescriber's instructions without question
- The extent to which a patient's behaviour corresponds with agreed recommendations from a healthcare provider (Correct answer)
- The patient's written agreement to take medication as prescribed
- The ability of a patient to obtain and correctly fill their prescription
Correct answer: The extent to which a patient's behaviour corresponds with agreed recommendations from a healthcare provider
Adherence describes correspondence between a patient's behaviour and agreed recommendations from a healthcare provider, reflecting a collaborative rather than prescriber-directed relationship.
Question 2: Research estimates that approximately what proportion of patients with long-term conditions do not take their medicines as intended?
- Around 10%
- Around 25%
- Around 50% (Correct answer)
- Around 75%
Correct answer: Around 50%
Evidence consistently shows that approximately 50% of patients with long-term conditions are non-adherent to their medicines, representing a major clinical and economic burden.
Question 3: A patient states they regularly forget to take their once-daily antihypertensive because of a busy routine. This is an example of:
- Intentional non-adherence
- Unintentional non-adherence (Correct answer)
- Therapeutic non-compliance
- Medicines management failure
Correct answer: Unintentional non-adherence
Unintentional non-adherence occurs when patients want to take their medication but face practical barriers such as forgetfulness, rather than making a deliberate decision not to take it.
Question 4: Which validated tool is commonly used in clinical practice to measure a patient's self-reported adherence to long-term medication regimens?
- FRAX score
- Morisky Medication Adherence Scale (MMAS) (Correct answer)
- PHQ-9 questionnaire
- AUDIT-C questionnaire
Correct answer: Morisky Medication Adherence Scale (MMAS)
The Morisky Medication Adherence Scale (MMAS) is a validated self-report questionnaire specifically designed to identify patterns of adherence and barriers to taking medicines.
Question 5: Shared decision making in the context of medicines optimisation requires that:
- The clinician makes the final decision based on the strongest clinical evidence
- The patient selects their preferred medicine from a clinician-generated list
- The clinician and patient work together using evidence alongside the patient's preferences and values (Correct answer)
- Agreement is reached between the GP and pharmacist before informing the patient
Correct answer: The clinician and patient work together using evidence alongside the patient's preferences and values
Shared decision making is a collaborative process where clinical evidence is combined with the patient's individual values, preferences, and circumstances to reach a jointly agreed decision.
Question 6: A patient with newly diagnosed type 2 diabetes declines to start metformin, citing concerns about gastrointestinal side effects. The most appropriate medicines optimisation response is to:
- Prescribe metformin regardless, as it is first-line and has a strong evidence base
- Explore the patient's concerns, provide accurate information about side effects, and collaboratively agree a management plan (Correct answer)
- Refer the patient back to the GP and document that they have refused treatment
- Respect the patient's decision and take no further action at this appointment
Correct answer: Explore the patient's concerns, provide accurate information about side effects, and collaboratively agree a management plan
Medicines optimisation requires exploring and addressing patient concerns through shared decision making, supporting informed choices and finding solutions such as dose titration or alternative formulations.
Question 7: Which of the following interventions has the strongest evidence base for improving long-term medication adherence?
- Simplifying the medication regimen by reducing dose frequency where possible (Correct answer)
- Providing written patient information leaflets with every prescription
- Increasing the frequency of prescriber follow-up appointments
- Issuing all long-term medicines in monitored dosage systems
Correct answer: Simplifying the medication regimen by reducing dose frequency where possible
Simplifying medication regimens — for example by using once-daily formulations or combination products — consistently improves adherence across a wide range of conditions and patient populations.
GPhC Medicines Optimisation 2
Which of the following best describes medication adherence?